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When patients are admitted to the hospital first of all they are received by a nurse on duty at the reception ward.
Those patients who are to be hospitalized have already received the direction from the polyclinic. The nurse on duty fills in patients' case histories in which she writes down their names, age, place of work, occupation, address and the initial diagnosis made by a doctor at the polyclinic.
Then a doctor on duty examines the hospitalized patients and gives his instructions what department and wards the patients are to be admitted to.
At the in-patient departments a hospital life begins early in the morning. The nurses on duty take the patients' temperature, give them intramuscular and intravenous injections, take stomach juice for analysis,apply cups and give all the prescribed remedies in the doses indicated by the ward doctors.
The nurses keep all the drugs in special drug cabinets. All the drugs have special labels (этикеткалар). The names of drugs are indicated on them. Patients are not allowed to take the medicines themselves because some drugs are poisonous, the overdosage of some other drugs may cause unfavourable reactions and even death.
At about nine o'clock in the morning the doctors begin the daily rounds of the wards during which they examine all the patients. After the medical examination the doctors administer the patients different procedures: electrocardiograms are taken, laboratory analyses of blood, urine and gastric juice are made. Some patients are administered a bed regimen, others are allowed to walk; some are to follow a diet to relieve stomachache or prevent unfavourable results in case of stomach troubles. All the doctors always treat the patients with great attention and care. There is no doubt that such a hearty attitude of the doctors to the patients helps much in their recovery.
How to Take the Case
When we become doctors, we should always remember the following things.
As soon as the patient enters the consulting, or when we enter his room, observation should begin immediately. We look for external signs and symptoms as long as the professional visit lasts.
How do you begin the consultation with the patient? A first requirement is to develop a feeling of sympathy with the patient by your questions, your actions, your interest in him and his troubles. Select and choose your questions well to be adequate for the situation.
Now when the patient begins to tell you his complaints, his signs and symptoms, and various diagnostic terms that have been given to his disease, you should carefully note what he is telling you.
When the patient has finished his description, it is for you to make clear some points he did not give in details. Your questions must be understood by the patient well to get a meaningful answer.
When questioning the patient your aim should be to make the patient feel free, so that he tells you everything. The patient must feel at his ease. Never hurry him – that is the worst thing you can do. When you record his symptoms, be sure to have the exact expressions used.
Always ascertain the exact region in which the patient feels this or that. When the patient has finished his story, and you have ascertained some points, then is the time to make your physical examination. There again be very observant and note all the visible signs or symptoms in all the regions of the body.
A good physical examination is important. First because only by knowing his physical impairments, his past diseases, can you differen-tiate between strange, rare and particular symptoms, and symptoms logically depending upon these results, i. e. common symptoms.
Secondly, a physical examination is important to establish the prognosis of the case: sometimes without a physical examination you cannot say if something is malignant or benign. The prognosis may be very different. If there is a malignancy you need more time for the cure than with a benign case if cure is possible.
Thirdly, a physical examination is important to establish an exact diagnosis. You might ask why is an exact diagnosis important. It is needed for the administration of a proper treatment.
So, you see now, how to take the case: first let the patient tell you his symptoms. Secondly try to clear up indistinct things precisely by careful questioning. Thirdly, make your physical examination.
Lobular Pneumonia
Patient Akbarov aged 48 was admitted to the hospital with the diagnosis of lobular pneumonia. He had been developing lobular pneumonia gradually. A week before the admission to the hospital he had had bronchitis after which his condition did not improve.
Fever had an irregular course and the temperature changes were caused by the appearance of the new foci of inflammation in the pulmonary tissue. Fever had been persisting for two weeks and had been decreasing gradually.
The patient's breathing was rapid with 30-40 respirations per minute. There was breathlessness and cyanosis of the face associated with the accompanying bronchitis, decrease in the respiratory surface and occlusion of numerous bronchioles and alveoli.
The patient complained of the pain in the chest, particularly on deep breathing in and cough with purulent sputum. The pulse rate was accelerated and arterial pressure was reduced.
On physical examination dullness in the left lung, abnormal respiration, numerous rales and crepitation were revealed. Dry rales caused by diffuse bronchitis were heard all over the lungs. The liver and spleen were not enlarged. The examination of the organs of the alimen-tary tract failed to reveal any abnormal signs but the tongue was coated.
The blood analysis revealed leucocytosis in the range of 12,000 to 15,000 per cu mm of blood and an accelerated erythrocyte sedimentation rate (ESR).
The urine contained a small amount of protein and erythrocytes. The X-ray examination of the lungs revealed numerous foci of inflammation of various size, irregular form and different intensity. Shadowing was particularly marked at the root of the left lung due to the enlargement of the lymphatic glands.
It was a severe form of lobular pneumonia which was difficult to differentiate from pulmonary tuberculosis and pleurisy. Yet the physician made a correct diagnosis.
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